How technology is highlighting the role of inflammation in depression and MS

At the 2019 MIT Space2 workshop, TechRepublic Senior Writer Teena Maddox spoke with Adam Kaplin, MD, Ph.D., at Johns Hopkins University School of Medicine about how depression is a common occurrence in multiple sclerosis patients, but an online app is helping patients better relay data about their mood to their physicians. The following is an edited transcript of the interview.

Teena Maddox: Tell me a little bit about the role of inflammation and depression.

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Adam Kaplin: So I ended up going into studying multiple sclerosis as an illness to understand depression because it has the highest rate of depression of any medical, neurological, and surgical disease. And of course it is a situation where the immune system generates inflammation right there inside and surrounding the brain, and spinal cord, and optic nerve. And this inflammation, we have now shown, is causative of the depression.

It doesn’t correlate with people’s disability and the two things we know in biology is to prove causation you have to show something is necessary and sufficient. We know that just a single immune system messenger, a cytokines it’s called which is like a neurotransmitter between two neurons. Cytokines are what immune cells use to communicate, and just a single cytokines interfere an alpha causes depression in 25% of people who get it when being treated for hepatitis C. It’s an older treatment, we have better treatments now, but that’s what we learned.

And we now have evidence, and we’re going to be publishing it this year, that shows that in MS, the first treatment that blocks inflammation, blocks the immune system from being able to get across the blood brain barrier turns out to be a potent antidepressant for people with MS who are depressed. And gee, if you can just rid them of their depression by treating the inflammation, that’s a pretty good way of demonstrating it is the inflammation causing the depression. It’s not personal weakness or the kinds of stigma that is associated with mental illness. People always blame themselves that gets in the way of them getting the treatment they need, and it’s actually lethal, the stigma in mental illness.

Teena Maddox: Now, tell me a little bit about the mobile health app and how that works.

Adam Kaplin: Sure. So about 10 years ago or 11 years ago, and you have to remember the iPhone started about 10 years ago. So this is before there were iPhones. I just realized, I was asking my patients to come in, making the diagnosis of clinical depression, giving the medications, psychotherapy, exercise, stopping the things that made it worse like alcohol or drug use, and I would send them out and have them come back. And I then ask them the question when they came back, say, for instance, a month later, or two weeks later, I would say, “How’s your mood now compared to how it was a month ago?” And that’s an absurd question, I realized, because I don’t remember what I had for dinner three days ago. How can I expect anybody know that?

So I started by handing out forms for people to track their mood, and we now know that the compliance or adherence with that is about 10%. People can’t find it, they don’t know where they left it. So I got with a company, Remedy Health, and they were willing to develop my ideas of developing a online version. So it’s not an app, it works at any phone and you log online to see it or on your phone, you can log on. But it’s basically mood two four seven dot com. So it is M-O-O-D, the numbers two, four, seven dot com. And it’s free, and once someone signs up a text each day, whatever time they designate, “How’s your mood on a scale of one low, 10 high?” And so they just can put view, seven, send and they’re done. Or they can put view, seven, put a space and write as much text as they want.

And the critical part of this is, then you can see it and search it like stock performance over time to understand what’s going on, but also you can share it with your doctor, your family, your friends. And they can all write into your mood chart. So it’s a mobile electronic health diary. We found some interesting things. One is that just that one question mood correlates with a elaborate tests of people’s depression, like the Montgomery Asperger test is one of the gold standards of testing depression. And the changes in the Mood 24/7 are right in line, ridiculously correlated, highly correlated. P-value is less than point O-O-O-O-O with the mood scores, how they change over time. So it’s highly accurate.

The other interesting thing is we’ve also found just by getting texted once a day, “How is your mood?” Over time, people start to understand the ebb and flow of their mood and it actually ends up being prophylactic. People given this Mood 24/7 are less likely to get depressed, and I think what’s happening is they can anticipate a trend in the wrong direction. And they say, “Well, gee, I was an eight, now I’m a six, now I’m four. I’m going down. Why am I going?” It just makes you sort of reflect and stop and think about it. And you then can have a measurement and you can talk to, you know, “My moods been going down.” You just talk to your doctor or even a friend and say, “I’m not sure why that is.” And just that conversation creates kind of the placebo effect. We know placebo is really just when people get into studies, it ends up dramatically improving their moods because they’re getting the support and psychotherapy of friends and other people asking how they’re doing and offering advice.

Teena Maddox: So it sounds like technology can play an important role in health care, but it hasn’t been realized yet. How are you guys doing that?

Adam Kaplin: So what’s really dramatic is that our machines are getting more and more advanced. In MS we went from one and a half Tesla, which is the strength of the magnet, to three Tesla and then seven, and now 11 Tesla. We can get the most detailed views inside the brain, and when I have my colleagues come and they present this information I say, “That’s great, but what are you correlating it with? What’s going on with the patient? Are they getting better? Are they getting worse? How are we tracking how people are doing, day in and day out?” And we’re not. And what’s really ironic is that patients now are tracking themselves. They’ve got Fitbits and Apple watches and these other kinds of technologies that’s telling how much sleep and all of this. And we are not using any of that in the medical profession and there’s this huge swell of technological ability that’s being developed, but not translating into what’s going on in medicine.

And when I talk to the residents, I feel like the woman in The Graduate, this old movie… Sorry, not the woman, the man. Her husband says, “I just have one word for you, plastic.” And I just want to tell the residents, “I just have one word for you, which is health information technology, or eHealth.” It’s the one where… because it’s going to revolutionize the way we practice medicine, the way we get outcome data on our patients. The way we can track them over time and stop this craziness of, like, how’s your mood now compared to how it was a month ago? Is an absurd question, and also it gives us the ability, like with Mood 24/7 that I can put in the patient’s note an update and know that the other physician that they see across town or in another city will be able to read what I said.

We don’t have to get on the phone and call each other. And when they see that patient, they will have them in their mind, they will look at their mood chart. And so what we’ve lacked is integration and good accurate information, and that’s coming because we have the technology. It’s just a matter of converting it into ways that patients will adopt and the clinicians will trust and be willing to administer.

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